聚乙二醇干扰素α-2a治疗合并自身免疫现象慢性丙型肝炎的相关问题探讨

Response to PEG-IFN α-2a by chronic hepatitis C patients with autoimmune features

目的探讨HCV感染诱导的自身免疫现象对PEG-IFNα-2a治疗的反应性及自身抗体水平在PEG-IFNα-2a治疗前后的变化,了解PEG-IFNα-2a诱发的自身免疫现象的规律及临床意义。方法采用荧光定量聚合酶链反应和聚合酶链反应-微板核酸杂交-ELASA法及间接免疫荧光法对24例慢性丙型肝炎(CHC)合并自身抗体患者、41例CHC不合并自身抗体患者进行PEG-IFNα-2a治疗前后自身抗体的发生率以及其与PEG-IFNα-2a治疗应答的关系分析。结果 65例接受PEG-IFNα-2a治疗后未出现自身抗体者对干扰素的应答相对较好,治疗前合并自身抗体的CHC患者对PEG-IFNα-2a的应答相对较差。自身抗体检出率在PEG-IFNα-2a治疗后有所升高,但治疗结束6个月后下降,且低于治疗前的阳性检出率。治疗前ANA、SMA阳性或治疗后出现ANA、SMA抗体者的应答率低。LKMA1、TMA、TGA与治疗应答率无明显关系。结论 CHC合并自身抗体患者对PEG-IFNα-2a治疗的应答率低于不合并自身抗体的CHC患者,PEG-IFNα-2a治疗过程中出现或升高的自身抗体可在治疗停止6个月后下降或消失。

Objective Study on a response to PEG-IFN α-2a in chronic hepatitis C（CHC） patients with autoimmune features and analyze the variation of serum auto antibody level before and after treatment.Methods HCV,HCV genotype,AMA,SMA,TGA and TMA were analyzed in 24 autoantibody positive and 41 autoantibody negative CHC patients before and after PEG-IFN α-2a treatment.Sandwich hybridization microplate,fluorescence quantification PCR and Indirect Immunofluorescence techniques were used.Results The response rate was higher in 65 autoantibody positive than autoantibody negative CHC patients before and after PEG-IFN α-2a treatment.The autoantibody reappeared with increased level at the end of PEG-IFN α-2a treatment,but decreased 6 months later to even lower than the pretreatment level.Response rates to PEG-IFN α-2a were significantly lower in patients with ANA and SMA compared to CHC patients without ANA and SMA.The response rate to PEG-IFN α-2a was not statistically significant between TMA and TGA.Conclusion Autoantibody positive CHC patients show lower response rate to PEG-IFN α-2a than autoantibody negative CHC patients.PEG-IFN α-2a treatment may result in the appearance and increase autoantibody level during the treatment of serious autoimmune disease,but may be recovered 6 months after the end of PEG-IFN α-2a treatment.